TRLOP perforators

What is TRansLuminal Occlusion of Perforators (TRLOP)?

Transluminal occlusion of perforators (TRLOP) is a technique to close small, but important, veins in the legs called perforating veins or "perforators". It was invented by Mr Mark Whiteley and Miss Judy Holdstock in 2000 at The Whiteley Clinic in the UK.

(This procedure was "reinvented" some 4 to 5 years later in the USA and called PAPS - "perforator ablation procedures" - but this procedure is identical to the previously described TRLOP. Hence TRLOP should be the term used to describe this technique)

Perforating veins are veins that take blood from the superficial veins just under the skin into the deep veins deep within the muscle to be pumped into the heart. As they perforate the muscle and the surrounding connective tissue called "fascia", they are called perforators or perforating veins. They are usually found in the lower leg but there are some in the thigh.

The Great Saphenous Vein has been closed by EVLA or Radiofrequency Ablation (RFA) stopping blood falling down it (reflux)

High pressure blood from the incompetent perforating vein (IPV) allows the blood to reflux into the dilated varicose veins

Varicose veins still causing bulges on the surface despite treatment of the Great Saphenous Vein

When perforating veins become incompetent, and allow blood to flow the wrong way out of the deep veins and into the superficial veins, they can either cause or contribute to venous problems of the legs including varicose veins, venous eczema, swelling of the legs, lipodermatosclerosis and leg ulceration. In such cases, the incompetent perforating veins need to be treated, to prevent this outflow of blood.

As with most medical terms, the term transluminal occlusion of perforators (TRLOP) states exactly what it is, but using medical terms:

•‘trans’ - means "across" or "through"

•‘luminal’ - means the lumen or the opening inside the vein where the blood flows

Therefore transluminal occlusion of perforators (TRLOP) is a technique where a device is introduced into the perforating vein to be treated (an incompetent perforating vein), and then once in position, the perforating vein is closed.